Life Saving Screening: Coronary artery Calcium Score Test
February is Heart Month and a great time to focus on heart attack and stroke prevention. The Coronary Artery (Non-contrast) Calcium Score Test is an accurate test to measure whether plaque is building up in the coronary (heart) arteries years before a heart attack occurs. However, few get this test and far too many people die each year from a heart attack that could have been prevented.
What It Detects
Atherosclerosis is the medical term for plaque buildup in the arteries. When born the arteries are smooth like the inside of the cheek. Risk factors damage the inside lining. High blood pressure roughens up the lining much like sandpaper. Excess blood glucose scratches it while moving through it. Smoking makes the blood very sticky and more likely to clump together.
Inflammation is the process where white blood cells move into the damaged area to heal it becoming red and swollen much like a pimple. LDL (Bad) cholesterol moving through the blood can become lodged in the wounded areas. Over time calcium deposits form from the inflammation. These deposits can be seen on X-ray (see arrow).
Over time the process worsens, and the damaged areas are vulnerable to rupture. Blood then comes in contact with the plaque buildup and a major blood clot forms which blocks the artery. Vital blood carrying oxygen can’t pass through. Most immediately experience pain and discomfort and some die from the erratic electrical fibrillations that stop the heart completely. The previous diagram shows how the rupture forms a blood clot.
Note that this plaque buildup is identified by the amount of calcium deposits noted on the test, a marker for atherosclerosis or plaque buildup. It’s called a subclinical diagnosis because most are unaware of the impending danger as it is occurring.
How It Works
Around 2000 a technology was developed that could capture X-ray images in between heart beats while the heart was briefly at rest. It examines the 4 main coronary arteries: left main, left anterior descending, circumflex, and right coronary artery. The amount visualized is tabulated into a total score. The radiation exposure in a non-contrast test is somewhat less than a mammogram.
What Do the Results Mean?
In simple terms it determines if one has none, small, moderate or a large amount of plaque building up. Atherosclerosis forms silently. It doesn’t cause a problem until the heart attack occurs. Those found to have larger amounts are treated more aggressively to prevent any further buildup. The following table provides general guidelines.
|
Calcium Score |
Recommended Follow Up |
|
0 (None) |
Lifestyle changes |
|
1 to 99 (Mild Amount) |
Lifestyle changes + statin therapy LDL <100 |
|
100 to 299 (Moderate Amount) |
All above but LDL <70 and consider low dose aspirin |
|
300 to 999 (Severe Amount) |
All above but LDL <55 and low dose aspirin recommended |
|
>1,000 (Extensive Amount) |
All above but consider emerging therapies |
Who Should Get the Test?
It is generally recommended for men over 40 and women over 50 with risk factors or a strong family history of heart disease. If your sister or brother had a heart attack you may have similar genetic vulnerabilities, and the test would rule out if you’re also at risk.
It is not recommended for anyone who had a heart attack. You’re at much greater risk for a second one and already should be receiving aggressive risk factor reduction care. The test would not add anything to your care plan.
Prevention: The Eight Essential Lifestyles
The following 8 Essential Risk Factors were identified by the American Heart Association. Managing them would help tremendously to improve heart health. Do check with your healthcare provider before initiating an exercise program.
- Quit smoking
- Increase physical activity
- Eat a healthy diet
- Manage a healthy weight
- Get a good night’s sleep
- Lower LDL cholesterol
- Keep blood pressure <135/85
- Keep fasting blood glucose <100
Statin Controversy
Recently a great deal of controversy arose regarding statin therapy and lowering LDL cholesterol. Good points have been raised regarding the accuracy and validity of earlier research connecting excess LDL cholesterol and heart disease. One of the most vocal who challenges the wisdom of statin treatment is Dr. Paul Saladino. He lives in Costa Rica, surfs 2 hours each day and consumes a diet rich in fish and fresh vegetables. However, even he agrees and stated:
If you’re insulin resistant and we lower your LDL cholesterol, your risk for heart disease is unequivocally lower. However, we didn’t treat the real cause which is insulin resistance or a metabolic disorder.
Interestingly, he is right of course but far too many people in America are insulin resistant and loaded with risk factors for heart disease. They most definitely would benefit from lowering LDL cholesterol. Once it’s lowered less will be available to move into inflamed areas which will then begin to heal.
Insulin resistance is a cluster primarily of several risk factors: excess weight, high blood pressure and glucose, low Healthy HDL (Good) Cholesterol, and inactivity. If those were controlled the need for statins might be reduced significantly.
However, some people live a very healthy lifestyle but inherited a liver that produces too much LDL cholesterol. The statin blocks an enzyme needed to make LDL cholesterol.
The best advice is to get the screening Non-contrast Coronary Artery Calcium Score test and follow up with a healthcare provider. If the score is low, you can focus on lifestyle changes. If it’s in the moderate or high range further tests may be needed to determine if that larger amount of plaque buildup is getting in the way of blood flow. Aggressive lifestyle changes will benefit everyone and statin therapy for those with positive calcium deposits.
On A Personal Note
Around 2000 our heart institute in the Chicago area was a beta site for this new technology. We asked patients to complete a form that indicated how they were controlling risk factors, drew blood to measure glucose and cholesterol levels and took a blood pressure. I was one of the cardiac nurses who sat with the patient and reviewed the preliminary calcium score results, their lifestyle choices, bloodwork and blood pressure.
One day I sat with a CEO executive from a Fortune 500 company and a truck driver. It was fascinating to learn that their questions were very similar. We found some people who were headed down the track at a rapid speed toward a heart attack and potential death. It was gratifying to intervene before the event and prevent that horrible outcome. Others just needed to tweak their risk factors and be more aware of their potential risk.
I now live in northern Idaho near Spokane, Washington. A few years ago, there were only 2 places to get this test. It’s now available at all radiology centers. It baffles my mind that few insurance carriers cover it even though it’s highly recommended by national guidelines.
During heart month most offer discounts if you pay out-of-pocket. Call your local facility and ask if they are offering a special during heart month. Most do. Give yourself a gift and get screened. Do what you can to live a healthier lifestyle. Don’t resist medications if your healthcare provider thinks you need them. If you’ve had this test, please comment below with your experience.
My first book Wake Up Call 911: It’s Time to Reduce your Risk for a Heart Attack and Stroke is available for $15 (which includes shipping). Just send me an email through my website and I’ll mail you a copy (www.jenniejohnsonrn.com). It’s a book that helps people reduce risk factors with simple changes.
Finally, I saw first-hand the magic of this test in really changing people’s lives. If they could be shown the silent damage building up, they were more motivated to make those changes to prevent a heart attack and take the medication prescribed by their doctor. You can view it in my article (note reference below).
Blessings to you all, as you take better care of the body God has given you, Jennie
Remember: Genetics loads the gun, but lifestyle pulls the trigger.
and
So, whether you eat or drink, or whatever you do, do all to the glory of God (1 Corinthians 10: 31).
References
“Screening: How Much Radiation is in a Heart CT for Calcium Scoring?” HelpDementia.com (September 17, 2025). https://helpdementia.com/screening-how-much-radiation-is-in-a-heart-ct-for-calcium-scoring/
“Coronary Artery Calcium Staging to Guide Preventive Interventions: A Proposal & Call to Action,” Journal of the American College of Cardiology (September 25, 2024). https://www.jacc.org/doi/10.1016/j.jacadv.2024.101287
“The Shawn Ryan Show: Paul Saladino SRS #179,” Vigilance Elite (March 5, 2025). https://shawnryanshow.com/blogs/the-shawn-ryan-show/srs-179-paul-saladino-the-fda-approved-poison-you-eat-every-day
- Johnson, Wake Up Call 911: It’s Time to Reduce your risk for a Heart Attack and Stroke (2015) jenniejohnsonrn.com $15 (includes shipping), https://jenniejohnsonrn.com
- Johnson, Does Knowledge of Coronary Artery Calcium Affect Cardiovascular Risk Perception, Likelihood of Taking Action, Health-promoting Behavior Change? Journal of Cardiovascular Nursing (January-February 30, 2015). https://pubmed.ncbi.nlm.nih.gov/24434820/
I’m a Christian nurse who helps people navigate the murky waters of healthcare
Author of Wake UP Call 911: It’s Time to Reduce your Risk for A Heart Attack and Stroke (2015) and Helping the Hurting: Nursing Ministry in the Body of Christ (2022).
You may visit my website for additional information: jenniejohnsonrn.com
All rights reserved 2026, Jennie E. Johnson, RN-BC, PhD
Paperback copies of both books for sale. Email me for details at: ask@jenniejohnsonrn.com.
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